Mortality from chronic liver diseases in diabetes

OBJECTIVES: Mortality from chronic liver diseases (CLDs) is increased in diabetes, but little is known about the etiology. The aim of this study was to assess mortality rates from CLD by etiology in known diabetic subjects living in the Veneto Region, Northern Italy. METHODS: A total of 167,621 diabetic subjects, aged 30-89 years (54.6% men), were identified in the year 2007 and their vital status was assessed between 2008 and 2010. Standardized mortality ratios (SMR) with 95% confidence intervals (CIs) were computed with regional mortality rates as reference. The underlying cause of death and all comordidities reported on the certificate were scrutinized in order to identify CLD deaths and their main etiologies. The latter were grouped into the following three categories: (i) virus-related, (ii) alcohol-related, and (iii) non-virus, non-alcohol-related (mainly represented by nonalcoholic fatty liver disease, NAFLD). RESULTS: Analyses were based upon 473,374 person-years of follow-up and 17,134 deaths. We observed an increased risk of dying from CLD in diabetic subjects with an SMR of 2.47 (95% CI=2.19-2.78) in men and 2.70 (2.24-3.23) in women. SMRs were 2.17 (1.90-2.47), 2.25 (1.98-2.54), and 2.86 (2.65-3.08) for virus-related, alcohol-related, and non-virus, non-alcohol-related CLD, respectively. CONCLUSIONS: Diabetic patients have a twofold to threefold higher risk of dying of CLD, mainly associated with a non-virus and non-alcohol-related etiology, which is largely attributable to NAFLD. An early diagnosis and treatment of NAFLD, if any, may have a beneficial clinical impact on the survival of diabetic patients

Donne immigrate e screening cervicale nel Veneto

According to the literature, women coming from countries with strong migratory pressure are at a greater risk of cancer of the cervix with respect to Italian women. This is connected with the fact that women born outside Italy are less likely to undergo a cervical smear. In the Veneto Region the official immigrant population is equivalent to approximately 10% of the total population. This article analyzes the utilization of cervical smear from immigrant women in the Veneto Region, taking into account the smears performed both inside and outside organized screening programmes. Data have been gathered both from the archives of the screening programmes of the Local Health Authorities and from PASSI, a national surveillance system based on a standardized questionnaire administered through telephone interviews. The screening crude participation rate among foreign women was 45.3%, only slightly lower than the one of Italian women. The participation is lower in women from Asia and in women above 50 years. The percentage of positive smear tests was 2.7% among Italian women and 4.0% among foreign women. Compliance to colposcopy has been 89.9% for Italian women and 88.1% for foreign women. The detection rate of cervical intraepithelial neoplasia grade II or worse (CIN II+ diagnoses) in foreign women has been twofold the one detected in Italian women. If we consider the number of smear tests carried out in the last three years and outside the context of screening programmes, the number of women who have undergone a pap smear is much higher among Italian women, women 39-45 years old and women with a high level of education and without particular economic difficulties. The opposite is true for the organized screening programmes, where the differences according to age, level of education, economic difficulties and citizenship are reduced. These data confirm that women coming from countries with strong migratory pressure are at a greater risk of cancer of the cervix with respect to Italian women. A decrease in inequalities (in terms of education level, socio-economical status and nationality) is shown when considering the access to the screening programs

Mineral equilibrium in commercial curd and predictive ability of near-infrared spectroscopy

Curd samples (n = 83) from 3 European dairy companies were analyzed for micellar and soluble mineral fractions content using inductively coupled plasma optical emission spectrometry as a gold standard method. The same curd samples were analyzed through 3 different near-infrared (NIR) instruments, and NIR spectra were merged with reference data. Prediction equations were developed using modified partial least squares analysis, and the accuracy of prediction was evaluated through leave-one-out cross validation. Overall, NIR spectroscopy was capable of predicting micellar and soluble mineral fractions in curd, but with differences among instruments. Fitting statistics showed that the visible NIR instrument in reflectance mode outperformed the NIR instrument in transmittance mode as well as the portable NIR instrument in reflectance mode. Prediction accuracies for most of the analyzed mineral fractions can be used for curd quality control in dairy companies and to aid in decision-making during the cheesemaking process

Malformazioni congenite: quale ruolo per l\u2019acido folico?

Pubblicazione in News & Opinions in Ginecologi

Prevalence of diabetes across different immigrant groups in North-eastern Italy

Type 2 diabetes, one of the most important non-communicable diseases, represents a major health problem worldwide. Immigrants may contribute relevantly to the increase in diabetes. The aim of the study was to investigate variability in diabetes prevalence across different immigrant groups in the Veneto Region (northeastern Italy)

Technical note: Repeatability and reproducibility of curd yield and composition in a miniaturized coagulation model

Miniaturized coagulation (MC) models have been proposed for the evaluation of curd yield (CY) in individual milk samples of different dairy species and breeds, and for the analysis of cheese microstructure and texture. It is still unclear if MC using less than 50 mL of milk is suitable to evaluate CY and chemical composition, and if preservative added to raw milk may interfere with MC process. Therefore, this study aimed at evaluating repeatability and reproducibility of CY, curd moisture, and fat and protein content on curd dry matter (DM) from MC trials using 40 g of milk. Miniaturized coagulations were performed by 3 different operators on 3 consecutive days, using raw milk (RM) and raw milk added with preservative (RMP). Repeatability of CY, calculated as relative standard deviation on 6 miniaturized curds obtained within a day by the same operator, was below 5% for MC carried out with both RM and RMP. The Horwitz ratio, which is the ratio between measured and expected reproducibility, highlighted good reproducibility for CY from RM and fair reproducibility for CY from RMP. The same ratio highlighted lower accuracies for curd moisture and fat and protein content on curd DM, especially for MC trials carried out with RMP. The z-test was performed to evaluate the similarity between curds manufactured with RM and RMP in terms of average yield and chemical composition; z-scores did not highlight significant differences between values obtained from MC carried out with RM and RMP. It can be concluded that preservative had negligible effects on MC, giving the opportunity to extend milk physical and chemical stability, to schedule laboratory trials on longer time span, and to broaden the sample size within a batch of analyses

Surgical Unit volume and 30-day reoperation rate following primary resection for colorectal cancer in the Veneto Region (Italy)

Abstract BACKGROUND: The aim of this study was to evaluate the impact of Surgical Unit volume on the 30-day reoperation rate in patients with CRC. METHODS: Data were extracted from the regional Hospital Discharge Dataset and included patients who underwent elective resection for primary CRC in the Veneto Region (2005-2013). The primary outcome measure was any unplanned reoperation performed within 30 days from the index surgery. Independent variables were: age, gender, comorbidity, previous abdominal surgery, site and year of the resection, open/laparoscopic approach and yearly Surgical Unit volume for colorectal resections as a whole, and in detail for colonic, rectal and laparoscopic resections. Multilevel multivariate regression analysis was used to evaluate the impact of variables on the outcome measure. RESULTS: During the study period, 21,797 elective primary colorectal resections were performed. The 30-day reoperation rate was 5.5 % and was not associated with Surgical Unit volume. In multivariate multilevel analysis, a statistically significant association was found between 30-day reoperation rate and rectal resection volume (intermediate-volume group OR 0.75; 95 % CI 0.56-0.99) and laparoscopic approach (high-volume group OR 0.69; 95 % CI 0.51-0.96). CONCLUSIONS: While Surgical Unit volume is not a predictor of 30-day reoperation after CRC resection, it is associated with an early return to the operating room for patients operated on for rectal cancer or with a laparoscopic approach. These findings suggest that quality improvement programmes or centralization of surgery may only be required for subgroups of CRC patients

A multicenter survey on profile of care for hip fracture: predictors of mortality and disability.

Summary Because delay in time to surgery beyond 24\u201348 h has been observed in many studies to be associated with adverse outcomes, a survey in nine centers in Italy was undertaken to examine the impact of time to surgery on mortality and disability at 6 months after hospitalization. Introduction Delays in surgery for hip fracture have been reported to be associated with negative outcomes. However, most studies are based on retrospective analysis of hospital discharge data, which cannot determine functional status or general health status of patients prior to the fracture. Methods Using a prospective cohort design, data were collected on 3,707 patients aged >50 years during hospitalization for hip fracture and in a 6-month postdischarge follow-up. Baseline information included age, gender, living arrangement, prefracture walking ability, walking aid, ASA grade, type and reason of fracture, time to surgery, type of surgery, date and destination at discharge, and osteoporosis treatment. Follow-up data included living arrangement, walking ability, and mortality. Results Six-month mortality was positively associated with increasing age, comorbidity, prefracture functional disability, and having surgery more than 48 h after admission. Higher levels of functional status at 6 months were independently associated with surgery occurring within 24 h of the fracture and with osteoporosis therapy at discharge. Walking disability was associated with older age, comorbidity, disability before fracture, and time to surgery after 24 h. Conclusions Delay in surgery is a major cause of mortality and disability at 6 months, and interventions to modify this pattern of care are urgently needed